Provider Demographics
NPI:1548783624
Name:GROVES, MELISSA (RD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:GROVES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MIDDLE ST STE 223
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4391
Mailing Address - Country:US
Mailing Address - Phone:603-294-1403
Mailing Address - Fax:855-462-9883
Practice Address - Street 1:1 MIDDLE ST STE 223
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4391
Practice Address - Country:US
Practice Address - Phone:603-294-1403
Practice Address - Fax:855-462-9883
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2018-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0907133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered